When is it Okay to Refill Your Prescriptions through Telehealth Visits?

Seeking out the prescribing power of an online medical provider to refill a prescription does not make up a large portion of telemedicine visits, but it is also not a rare occurrence.  According to the Centers for Disease Control, about 50% of us are on at least one prescribed medication, 23% take three or more, and 12% take 5 or more medications.  For the 50% who take regular medications, many of us see that we are approaching the end of the prescription and say to ourselves "I need to get my prescription renewed soon".  But life often gets in the way and we never get around to it.  Or, if we do not have refills waiting for us, we need to make an appointment with the prescribing medical provider which can be days to weeks away and we end up running out before we can make or get the appointment.  Under some circumstances, we might even decide to simply not refill the medication because we feel fine and think we do not need them anymore, or we don't like the side effects.  This last scenario is common with things like blood pressure medications and cholesterol-lowering medications.  Heck, the last time the blood pressure and cholesterol tests were checked they were normal, right? (Hint: the medications are probably working as they are supposed to and stopping will possibly change those nice results)

Common Scenarios When an Online Prescriptions Refill Is Used

You should plan ahead so that you can see or at least talk to your medical provider in time so that you do not run out. But the reality of what should happened and what does happen are often different.  So when in a prescription bind, there luckily are multiple telemedicine services willing to help out.

Let's take a look at a few commonly seen circumstances when an online refill is used:

• Traveling and forgot the regular medicines back home
• Ran out of medication with serious withdrawal risks
• Ran out of medication where not taking it short-term will worsen the underlying medical problem
• Medication was lost or in rare circumstances, stolen
• There is an appointment with the regular care provider, or a new one, but the needed medication will run out before the appointment and they will not provide a short-term bridge prescription without being seen first.
• Taking medications but no longer have a doctor - doctor retired, patient or doctor moved, lost or changed insurance, etc.

Limitations of Telemedicine Prescription Refills

1. To start, if you are going to go this route to get medications refilled, be mindful that the prescriptions will usually be a short-term refill.  So you are not off the hook with getting that prescription refilled through a regular medical provider.
2. Also, many telemedicine services limit prescription refills to just a few times per year.  So this cannot become your standard method of obtaining medications.
3. Additionally, nearly all telemedicine services do not allow for the prescribing of controlled substances such as narcotics and anxiety meds/muscle relaxants. Under most circumstances, prescribing of these Drug Enforcement Agency controlled substances without an in-person examination is a violation of the Ryan Haight Act.  There are a few exceptions to this regulation, these exceptions are relatively rare and are beyond the scope of this article but you can find a good discussion of these exceptions from telemedicine legal expert Nathaniel Lacktman here.

Risks of Running Out, Stopping, or Rapidly Decreasing Certain Medications

There are several types of medications that if you are taking them long-term, you really should not be running out or going cold-turkey without them because of potential problems with suddenly stopping.

Let's take a look at a few:

1. Blood pressure pills - As mentioned above, this is also one that many people decide to simply stop because they have had normal blood pressures recently and do not think they need it or want to spend money on it anymore.  Adequately controlling your blood pressure is associated with a significantly reduced risk of stroke, where more than 50% of cases are attributed to high blood pressure.  Similarly, the risk of heart attack and heart failure can also be reduced with good blood pressure control.  So you literally are increasing your risk of stroke, heart attack, and dying by not taking your medications.  Even worse is if you are out of one particular blood pressure medicine called Clonidine(Catapres).  Stopping this medication suddenly can lead to a rebound blood pressure effect where you can get extremely high pressures, also putting you at risk.  Other blood pressure pills such as the class called beta-blockers(metoprolol, propranolol and others) are also associated with withdrawal effects and increased risk of heart irregularities and death when stopping them suddenly.
2. Benzodiazepines - This category of medication is commonly used for anxiety and muscle relaxation and all are considered DEA controlled substances.  Stopping these medications suddenly is associated with the risk of having a seizure, generally within the first few days after stopping.  While you will not be able to refill these online legally in most circumstances, you should plan ahead to make sure you do not suddenly run out.  If you are going to stop long-term use of these medications, it is generally best done through a monitored slow wean off the medication as directed by a doctor or other licensed medical provider.  Medications in this category include Valium, Ativan, and Xanax.
3. Antidepressants - Not only can stopping antidepressants suddenly lead to a sudden worsening of the depression, including leading to suicidal thoughts and behavior, but the withdrawal symptoms can be very unpleasant as well.  Some the the withdrawal symptoms may include vomiting, diarrhea, head and stomach pain, nightmares, inability to sleep, sweats, and tremors.
4. Narcotics - Narcotic addiction is a major problem in our country.  And while narcotic withdrawal itself is unlikely the cause someone to die, the symptoms of withdrawal make it feel that way and can be so powerful and unpleasant that getting rid of withdrawal symptoms is a key component of the cycle of addiction.  These withdrawal symptoms commonly include runny nose, yawning a lot, sweating, vomiting, stomach pain, agitation and anxiety, insomnia, high blood pressure, fast heart rate, and depression.  Similar to benzodiazepines, these medications usually cannot be refilled through a telemedicine evaluation.  Entering a controlled narcotic treatment program is recommended.
5. Steroids - Long time steroid use is associated with a long list of side effects, but stopping suddenly can be dangerous too.  Prolonged steroid use decreases our natural hormone activity of our adrenal glands which can take months to recover.  Stopping or tapering off too quickly can lead to vomiting, severe weakness and fatigue, dizziness, as well as body, stomach, and joint pain.

There are additional types of medicines associated with significant withdrawal symptoms such as some seizure medications, muscle relaxants, headache medications, and even aspirin.  So it is generally recommended to plan your stopping of most medications but particularly those in the categories listed here.

Information for Getting Your Prescription Refilled Online

For those that are not considered a controlled substance, many telemedicine services are happy to help you bridge the gap between being out of a medication and getting in to be seen again to renew your long-term prescription. Getting back on your meds can be as simple as a phone call or video chat. Many primary care doctors are now starting to use telemedicine as part of their practice.  With access to your records, they may be able to renew longer-term prescriptionswithout the need for an office visit.  No matter where you obtain your online prescription from, it is helpful to have the following information readily available (having the actual bottle or prescription information in your hands at time to the visit is recommended):

1. Your full name and date of birth
2. The name of the medication
3. The dose or strength
4. How often you take it
5. How long has it been since it was last taken
6. All other medicines you take(including over the counter and herbal medicines)
7. Any allergies to medications
8. For children, how much the child weighs as medicines for kids are often based on weight
9. The name, location, and phone number of your preferred pharmacy

Conclusion

Getting a short-term refill of your regular medication through a telemedicine service is legal, quick, easy, and inexpensive.  However, unless your regular doctor is using telemedicine, this method is great for getting you out of a pinch but not the best method for your long-term medication management.  Keep an eye on your prescriptions, when they will run out, and plan accordingly.  There are several services available to you to help you out in your time of need, and there likely is one in your home state.

As a final word of advice, make sure that the service you use to obtain your prescription refill is legitimate.  If it is not your regular care provider, most legitimate telemedicine companies either list the doctors or licensed medical providers on the website or your can see who is available to see you once you sign into their service.  Consider calling or getting on the website of your state's medical board and find out if the medical provider is licensed in your state and check to see if they have any negative medical background you should be aware of before proceeding.

Care On.